← Chapter 9
Maternal-Newborn & Paediatric Nursing · Chapter 9

The 24-Hour Rule

Jaundice appearing in the first 24 hours of life is pathologic until proven otherwise, and there is no exception to it. Triage a real bilirubin against that rule, the rate of rise and the direct fraction with every line of arithmetic on screen; separate the two feeding jaundices that are managed oppositely; follow one newborn as the findings escalate; and sort the phototherapy actions that keep the treatment safe.

Work the bilirubin

Jaundice becomes visible at roughly 5 to 7 mg/dL and progresses cephalocaudally — face, then trunk, then extremities, with palms and soles last. Visual estimation is unreliable, especially in infants with darker skin: blanch the skin over the sternum or check the sclerae and gums, then get a number.
Triage the bilirubinOnset, rate of rise, direct fraction
Waiting
Enter the values on the left.